[Student assessments in palliative medicine as the cross-disciplinary subject 13: Survey of 34 medical faculties in Germany]. / Prüfungen im Querschnittsbereich Palliativmedizin (QB 13) : Befragung an 34 medizinischen Fakultäten in Deutschland.

BACKGROUND: In 2009 palliative medicine was integrated into the undergraduate curriculum as cross-disciplinary subject 13 and is now part of mandatory education in German medical faculties (MF). Surveys across German MFs have shown an inhomogeneous development of this cross-disciplinary subject. The aim of this study was to assess the current state and the needs in terms of assessments in the cross-disciplinary subject 13 at German MFs. MATERIAL AND METHODS: Palliative care coordinators at German MFs were surveyed by using a standardized telephone interview. Closed-ended questions were analyzed by descriptive analysis and open-ended questions by content analysis. RESULTS: A total of 34 out of 36 MFs participated. Multiple choice tests were the major form of assessment (94.1%) and 9 MFs planned to implement another form of assessment, mainly an objective structured clinical examination (OSCE) station (55.5%). The majority of the MFs (91.2%) had no blueprint to develop assessments but conducted a review (78.8%) afterwards. A successful implementation of the assessment was mostly achieved when the concept of the assessment was felt to be suitable. The lack of human resources was found to be the most relevant obstacle for the implementation of a practical assessment format. CONCLUSION: The major form of assessment in palliative care is still a written examination, especially multiple choice tests. This format is considered to be of limited value for assessing communicative competencies and attitudes in palliative medical care. Further steps should include the development of a competence-based assessment that is also feasible for smaller MFs with limited resources.

Effect of post-mortem storage on Ca(++)-dependent proteases, their inhibitor and myofibril fragmentation.

Post-mortem changes in two calcium-dependent proteases, their inhibitor, myofibril fragmentation index (MFI) and collagen (amount and solubility) were studied. Whereas the activity of high Ca(++)-requiring calcium-dependent protease (CDP-II) remained nearly constant throughout post-mortem storage, there was a progressive decrease in the activities of low Ca(++)-requiring calcium-dependent protease (CDP-I) and their specific inhibitor, with the inhibitor being the most susceptible to post-mortem storage. Results indicated that the greatest changes in MFI occur within the first 24 h of post-mortem storage. There were no detectable changes in either total or soluble collagen content with post-mortem storage. Hence, it was concluded that improvement in tenderness resulting from post-mortem storage must be derived from changes in the myofibrils and since CDP-I activities paralleled the myofibrillar changes, it seems reasonable to suggest that CDP-I, not CDP-II, plays an important role in the fragmentation of myofibrils and consequently in improvement of meat tenderness resulting from post-mortem storage.